Listen to the podcast here: When my Panel is full.. What Next?
Episode Summary: In this podcast episode of DPC Pediatricians, Phil and Marina discuss what it means when a Direct Primary Care practice reaches a full patient panel and the strategic decisions that follow. They explore how every physician’s definition of “full” is different, balancing patient volume, income goals, and work-life satisfaction, while sharing practical options such as implementing a waitlist, adjusting membership pricing, hiring additional clinicians, or expanding services. The episode encourages physicians to view a full panel not as a stopping point, but as an opportunity to intentionally shape the next phase of their practice in a way that aligns with their personal and professional goals.
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC Pediatricians who are on a mission to share our love of direct primary care with you.
Welcome everyone to another episode of the DPC Pediatricians podcast. Thanks for joining us today. Phil and I are going to have a conversation about what to do when our panels are full. This is obviously not something that people are thinking about in the beginning stages of DPC journey,
but everyone reaches that full point at a different time on their trajectory. So some people get full in a year, some people take four to five years to get full. But once you get to that point, or once you start nearing that point, it’s important to start thinking about how am I going to handle this?
Do I want to keep growing my clinic? Am I just a solo practitioner and I want to stay that way forever? And therefore, I’m just going to have a cap and reach it when I reach it. So Phil, I’m curious as to your thoughts. Did you start thinking about this?
First of all, when you opened your DPC, at what point did you start contemplating that?
So for me, I didn’t really think about this when I first opened is like, what does a full panel look like? And how will I know? And I think that is something that is different for each person. Sometimes full is a salary number.
Full is a patient number or full is a hours per week or those sorts of things. And I didn’t really… Think about that. I think in part because especially when you’re first starting out, like you don’t know how fast it’s going to go. And so to think about like, well,
what am I going to do next feels like jumping way ahead and maybe even jinxing yourself. So it wasn’t something that I thought about. I think… It’s also interesting to from the pediatric side versus the family practice side, because I think a lot of us learn a lot of DPC from the family practice side
because it’s much larger. There’s more, you know, organization, the Facebook groups are bigger and all those sorts of things. And so then it’s like, well, a family practice is full at, you know, 500, 600. In part because adults utilize the services a lot less and a lot less frequently
and you’re not doing the amount of daily and weekly interactions that you are with a lot of your families in pediatrics. And so it’s hard to even know what that number is going to be. So I guess I would throw it back to you, Marina. What do you think, like,
how would you define a full panel for yourself or for the solo practitioner that’s like trying to start and grow? What sort of metrics should one be looking at?
Yeah. Well, I like what you mentioned that full can be defined in different terms. It can be based on salary. Are you making your goal salary yet? Right now, usually when I advise physicians who are starting their DPC, I have this whole, you know, numbers game that we play. It’s like, okay, first set your goal salary.
What do you want your goal salary to be and account for taxes and account for retirement account for health insurance, all those things. And then what are your monthly overhead expenses? And when you tally all of those things, you come up with a total number of how much you need to be bringing in each month
in order to cover your overhead and pay yourself what you want to pay yourself. And then you say, OK, what do you think is a reasonable based on your goal for your practice? Let’s say you’re doing home visits only versus in clinic. Let’s say you’re doing only three days a week versus four or five days a week.
So you kind of think through what’s a realistic panel. And I would say most DPC Pediatricians fall somewhere in the 250 to 300 range an in-clinic model of the ideal number of patients that they could handle. Now, it’s going to be highly variable because, again, if you’re doing home visits, it might be only 100.
If you’re doing more intensive integrative medicine or lifestyle medicine, it might be 150 to 200. So it really depends and you have to consider all those things. But I advise physicians to figure out that number and figure out how much you have to charge per member per month.
I don’t want people to end up in the boat where they undercharge and then they realize, oh my gosh, like I’m only making 60% of what I want to make and I’m feeling at capacity. And then you have to overburden yourself in order to make what you want to make.
And what people realize at that point is that they have to raise their prices. So there’s that way of figuring it out, right? Like you did the math in the beginning and you reached your goal number versus like you’re making what you want to make versus what you said, actually,
which resonates a lot with me is like my time and is my time and capacity, right? And what I realized partway through my practice was that I was working more than I actually wanted to work. And so this year I’m kind of scaling back from four days a week to three days a week.
And I’m realizing, oh, I’m definitely pretty full for three days a week. And it’s three long days per week. But still, that’s what that’s my sweet spot. So when it comes to determining what that full means for you, you can do it in any of those ways. And your number,
your salary number is going to be different than everybody, well, than other people. And your cap, your number of members cap is going to be different. And maybe, I mean, everybody wants to work a different number of days. Want to be in the office five days a week because they’ve got stuff going on at home
and it’s easier for them to be in the office to accomplish everything. For me, I don’t like being in the office five days a week. Three days a week is my happy place because I want to be able to fit in other things and work from home those other days. Now, if there’s something truly urgent, of course,
I may go into the office to see a member, but I live close enough that that’s pretty easy. So what about what about for you? What does that look like for you in your mind?
I think for me, in my mind, it does come down at this. And I think it varies as you go through, like starting out versus when you are getting closer to that full place and like the comfort of, okay, I have enough patients. Things are going okay. I can be choosier with my time.
I can be choosier with my patients. I think that has evolved over time as well, where now we’re like, okay, we have a wait list. We’re a little bit in a choosier place. And then I really focus on my time. Am I doing with my time? What is most valuable to me?
Or is our panel so full that it’s taking up more time than I’d like? So for me, that’s kind of how it came down to is like, I see patients in clinic three days a week. And then I have two days where I’m kind of doing all a mix of stuff for the practice
in terms of administration and marketing and growth and those sorts of things. And then all the other things that I like to fill my time with.
Like this.
Like this. Exactly. Yes. So that for me feels like a good place. And then when I’m trying to decide, okay, is our practice full? I usually just look at our schedule and I see what capacity looks like, like how busy are we this month? With checkups. And that’s kind of the easy barometer for me.
If patients can get in for a checkup within the next two weeks, no problem. And there’s a plenty of availability, then that doesn’t feel too full for me. Because that says to me that we have ample visibility. But if they can’t get in within two weeks for a checkup, then that would tell me.
And like, obviously we have more sick days and accommodate and all those sorts of things. But I think the useful barometer that I found lately, at least is sick or checkups because If you can get in with two weeks for a checkup, then if you have a brand new baby,
they’re not going to have trouble getting in and no one else is scheduled. No one else really needs a checkup within two weeks. And so to me, that feels like a really useful barometer, especially when I look at the rest of the practices in town that are booked out two
or three months for a checkup that we can say, yeah, we can do your checkup next week or the week after that. No big deal. And so that’s kind of been The barometer for me. Now, the tricky part of that is like summer versus winter. And so in the winter,
it’s going to be busier because you’re going to have a lot more sick visits. And so we kind of have to keep that in mind. So I don’t feel like there’s a specific number and I feel like I’m rambling a little bit as I try and do the math or work through the math here.
But I think for most people, it’s more of a vibe than like a hard and fast number.
Definitely. I’m curious though, Phil, you technically already got full and you hired another provider. So tell me what, like go back in time and tell me a little bit about what that decision making was like for you at that time.
So for us, we started looking and found somebody, a nurse practitioner for part-time nurse practitioner position before we were full. And we kind of could see the writing on the wall of the trends of getting busier and those sorts of things. And I also wanted to make sure that I was able to start doing things like this,
keep doing other activities, business-related, entrepreneur-related that I like doing. And so it became a, okay, I don’t wanna work every Saturday. I want to find somebody that can help to unburden Saturdays a little bit. And that led to, let’s see if there’s anybody that would be a good fit. And we found a good fit really quickly.
So this was around the one year mark where we found a nurse practitioner that was Very primary care focused, had a ton of ER experience and was IBCLC and had a ton of psychiatric experience too. So it was really like the right person and let’s figure out how to make it work so
that we can keep growing our panel and have that person that can fill a lot of gaps in our expertise.
Yeah. So for you, the solution is Well, maybe it wasn’t just because you were full, but it was related to other things. Like you wanted to free up your Saturdays. You wanted to have more help, right? Which completely makes sense. That’s a perfectly valid reason to hire someone else. But for you getting to that point,
when the solution was hiring someone else, getting someone else on your team, I think that that can be intimidating for a lot of pediatricians because you do so much work putting your personality into your practice and selling yourself. And all of a sudden, if someone else is in your practice, how does that change your whole brand?
How do people choose between physicians or providers? And there are all those questions to grapple with. But that is definitely something that you can do once you’re getting to the full point. And I’ve seen more and more conversations popping up in our Facebook group about, hey, I’m getting full. Talk to me or can I talk to someone?
Will someone talk to me about how to hire another physician, how to hire some help in my practice? Because that can be a whole arena of its own. Oh, for sure. Tricky territory to navigate of how to create that contract, how to incentivize somebody to work As I mean, not maybe as hard as you do,
but to work hard in order to attract patients because we don’t have so much cushion in our practice that we can easily guarantee a salary forever. So there has to be some sort of incentive system built into that. But I have seen more of those conversations popping up.
I myself am looking for another pediatrician at some point this summer or fall. I hope to find a good fit. I did interview someone. And it didn’t turn out to be a great fit, but I mean, I liked her, but it just wasn’t a good fit for my practice and my model, especially with the integrative medicine part.
So I hold out hope that I will find the right person at some point this year.
Well, and I think part of it too, to your point of like my patients want to see me because at first it is all about you and like making those relationships. And then I think as your practice grows, we’ve intentionally tried to shift to the model and the offerings rather than me as like the draw.
And that has worked really well. And our patients love getting to see. So we have myself, we have Claire who’s a nurse practitioners who are part-time, and then we have a PA, Lindsay, and it’s really intentionally We’re part of a team and you get to see
and participate with the whole team rather than you have like your specific person that you see each time or I signed up just to be taken care of by Dr. B or by Lindsay or something along those lines. We’ve really intentionally tried to make it into the benefit is the model and
the benefit is the ease of access and the feel that we are a very small clinic that you have a very personal relationship with rather than About like getting to see a specific person.
Gotcha. Although I’m sure a lot of your patients, cause you have such a big social media following. I’m sure some patients come in saying, Hey, I saw your stuff online. How do you navigate that discussion? Yeah.
I mean, I think. That does happen to some degree. I think we, we let people when they, if they, if they want to come in and do a ADHD evaluation or something like that, we send them a link that lets them pick who they want to see. And when they do that, then it shows availability.
And those sorts of things. But then I think as they spend time in the practice, they realize that like everybody has those same skills and expertise and we all work collaboratively. So I think that’s a big difference too, is that there’s more of that collaborative feel. To the practice, but it does take intentionality,
especially like I’m thinking about when we have newborns that come in and maybe they saw some newborn content that I did or something like that. We intentionally make sure that they schedule with the different team members so that they get that fresh face with everybody or FaceTime with everybody really so
that they can see that our whole practice is perfect for you. Even if you were initially drawn in by one piece of content or a specific offering that we had that everybody’s great and helpful and can Yeah. Yeah.
And probably they just feel the difference of like, oh, this is a longer appointment. It’s not a rush. Like I can text my team like that alone really stands out. And I’m sure that they as they get to know the different people that if you hire good people, they’re going to like you.
They’re going to like your practice.
And we have such great people that like, I’m very happy to see when people are booking, like we, when people book a checkup, they can pick who they want to book with and they pick all three of us. Um, and it’s really nice to see that, like, they feel really comfortable with that and like that.
And some people prefer to see me, some people prefer and almost exclusively see Clara or Lindsay. So it’s just kind of fun to see how those things come out over time.
Yeah. Excellent.
So let’s say that you get to that place of your full, whether it’s the hours that you’re working, whether it’s the salary, whether it’s the number of the panel size, what do you do then? And I’m curious how you would approach that.
Well, as we discussed, option number one is hire someone else, right? And that we’ll probably do an episode at some point on that, interviewing other physicians who have done it in this DPC space. But For now, that’s your first option. Second option is, let’s say you just really want to be solo.
You never want to be an employer. You don’t want to be responsible for another physician or another NP or PA, etc. And you just want to stay at your perfect panel size and your capacity. So option number two is really just to say, hey, this is my limit and everybody has to go on a wait list, right?
Now, I have seen people navigate that a little differently. Some people will technically have a waitlist for anybody who’s completely new and is interested, and then they just stay on that waitlist until one of your member family leaves or moves, etc. However, in that case, most pediatricians will still keep seeing the newborns that are born into
the families of their established family. So you will still be growing a little bit, but it depends on how many newborns obviously are being born in your practice and how many families you have under your care. So that’s a perfectly legitimate option. If you want to remain a solo practitioner,
you can absolutely just cap it where you cap it and have a wait list. And maybe let’s say you find another practice in your community that’s doing something similar to you. You could always refer patients, help out that practice. If you don’t need the families,
you can refer them to a fellow DPC physician or DPC pediatrician if you’d like. But otherwise you just, if you really want to stay small and you’re at capacity, you just have to make that decision no more. Right. Or, but I think it is wise to have a wait list because at some point,
let’s say something happens in the economy or, um, A bunch of your families just happen to move for whatever reason or go through something financial and have to leave, then you do want to be able to replace those. If you stop marketing altogether,
then that’s where you get in a tricky situation where it’s like, oh, I was okay. And then suddenly I backtracked. How do I fill those spaces now?
Right. And I think that having a wait list is a great way to just kind of have those people. I’m always surprised that people will wait on a wait list because I feel like For me, and Marina knows me well enough to know that I’m like the one on Charlie and Tractor Factory, like I want it now.
And so I feel like everybody must be like that. And if we tell them you’re on a wait list and there might be a couple of months and then we go to them and be like, hey, we do have a spot for you. They’re like, heck yes, I’m ready.
Whereas I felt like I would have moved on by then. I think something else, if you get to that point where you’re like, okay, I’m full then, and I’m making the money that I want to make, and I’m taking the time that I want to make, and I don’t want to grow anymore.
I would still encourage pediatricians at that stage to say, maybe I can go now that I’m full and in, you know, in a good place, perhaps this is the time that I want to hire a little bit of help. And it might just be part-time help and it might just be virtual help
or it might be something along those lines so that I can reclaim some of my time because I’ve worked really hard to build this practice up, but I’m doing a lot of like the clicking of the minutiae clicking and perhaps there’s somebody So I would encourage people that are at that stage,
if you’ve grown and been solo, solo, then I would say, okay, if you get to full, then you should give yourself a pat on the back and you should give yourself a couple hours back per week to hire somebody that can take, can unveil Yeah. Yeah. Yeah. Yeah. Yeah. Yeah, absolutely. Yeah.
Let’s see, are there other options? I mean, basically you either hire someone else to increase capacity or you just say, nope, I’m good. I’m good where I am.
Sorry, I was going to say one other thing that I think of too is like outside of just being like, I’m full or hire somebody else and keep growing that way is you could grow sideways of I’m not going to see more primary care patients,
but perhaps there’s a specific area of interest where I want to learn more and then start offering that maybe not as a full primary care process. But as a specific side niche. And so I’m thinking here of kind of the integrative stuff that you do,
or we do a lot of ADHD and autism and things along those lines where they still have the regular pediatrician. Like we are wait-listed for them. We don’t offer them a membership, but we can’t see them for their ADHD. We can’t see them to support autism and those sorts of things as a way
to clinically keep growing and revenue-wise keep growing, but also to fill that brain itch of like trying something new or getting in the weeds on a specific area of interest. So I think that’s another option that really is open to you when you get to
the point of like, we have a really good primary care thing going here. Maybe I’ve gotten some, reclaimed some of my time and I want to see a specific niche, whether it’s babies with congenital heart disease or autism or ADHD or asthma or anxiety or whatever sorts of things that, you know, strike your fancy.
Yeah, absolutely. Yeah, in fact, I’m doing a little bit of that. I’m pretty much full. And so I had increased my prices a couple of months ago and just to kind of slow down growth, but also so that the new families that join Right.
Are also a little more financially viable with the limited schedule of three days a week. But I decided that I really want to open my practice to a subset, small number of adults. And so I need to make the time for that. And so that’s one thing that I’ve been considering the last few months is like, okay,
where am I going to fit in these adult patients at a time that works for me and also would work potentially for them if they’re working? And yeah, I’m doing a little bit of that, that kind of lateral growth of like, okay, I want to shift the focus a little bit.
I’m at capacity in terms of my time, but I’m always interested in like, okay, what’s the next thing that I can learn? What’s the next thing that I can master? What’s the next way in which I can grow and evolve? And I feel like this was calling to me is working with more complex adults
that haven’t really found the help that they need. In other places within, within modern healthcare. So yeah, I’m going to see how it goes. I’m just waiting for my purse patients.
So I think for, for those that are listening, like if you are just starting out or just kind of toying with the idea, I think it’s fun to think about a couple of years down the road, what that looks like when you’ve built a full practice and can really do that.
And for those that are in the growth phase right now, like, how am I going to know when I’m full? Like, what does that feel like? That’s the thing to kind of sit with and figure out, like, What will it look like when I’m full and how will I know that I’m full?
And then those that are full, how can I reclaim some of my time? Because I think time is our most valuable resource, whether it’s time at work or time with family or time to ourselves or our hobbies or sleep or whatever it might be, that that’s really important.
And for those that are at that stage, What does it look like? And oftentimes it’s not like full closed forever. It might be full for this season of life and then I want to reevaluate and go forward from there. And I think that’s what one of the biggest benefits of DPC is it doesn’t have
to look the same in three years as it looks now. It could look radically different Doing things that you had never considered before that now you are doing because you have the freedom to move and flex and pivot in a way that in a traditional fee-for-service practice,
you kind of have a good idea that like in five years from now, I’m going to be doing pretty much the exact same thing. Maybe having to see more patients or document more, but my job is going to look very similar. Whereas in DPC, it can look radically different.
Absolutely. And it really gives us the flexibility to reinvent ourselves, right? If you’re halfway or let’s say two years into your practice, you realize that you really love doing breastfeeding medicine and you want to go more in that direction, or you really love working with kids on the autism spectrum and you Want to go more that direction?
You can do that. And that’s a freedom that we never had in the insurance-based employed world. At least very rarely do people have that. So absolutely agree with everything you said. And start thinking about now, even if you’re early in your trajectory, start thinking about what does full look like for me?
How am I going to measure that? How am I going to know when I’m getting there? Are my prices at the right point so that full is going to work for me financially as well as time-wise?
Exactly.
Thank you. Yeah. Well, thanks everyone for listening. We hope you found this helpful. Remember, we have a ton of resources available at our website, dpcpediatrician. Both Phil and I do one-on-one consulting. I also have some group coaching programs. In fact, we just started the Startup Foundation’s group coaching program last month, and it is going wonderfully.
I’m really enjoying teaching that, and participants are really engaged and talking about Just the vision that they have for their practices so that they start out on the right foot from the beginning, envisioning the practice they truly want, not just copying and pasting someone else’s dream practice.
And then this month we’re talking all about the finances and working on budgets and startup costs and all of that. So we are not taking people for this cohort, but we will probably be having another cohort starting in the fall. So check out our website, get on the wait list if you’re interested. And thanks again for listening.
